新型冠状病毒感染疫情防控期间防护装备所致医护人员皮肤损伤的发生率及流行特征研究

背景　医疗器械相关性皮肤损伤主要发生于危重患者和矫形患者,一直是全球住院患者安全管理和专科护理的研究热点,但尚缺乏关于医护人员的报道。本次新型冠状病毒感染疫情防控期间,大量医护人员奋战在抗击疫情第一线,长时间穿戴防护装备容易引起皮肤损伤,严重危害了医护人员的健康,也增加了其被感染的风险,如何保护医护人员免受伤害成为亟待解决的问题。目的　探讨新型冠状病毒感染疫情防控期间防护装备所致医护人员皮肤损伤的发生率及流行特征,为制定有效的防护对策提供依据。方法　由本课题组研制调研问卷,主要内容包括医护人员的基本情况、防护装备佩戴情况、皮肤损伤情况、针对皮肤损伤的防护措施及损伤后处理情况。问卷通过“问卷星”网站发布,于2020-02-08至2020-02-15通过微信向抗击疫情一线的医护人员进行推送,采用自愿参与、手机“问卷星”在线填写的方法完成调研。1周内完成调研数据收集,建立数据库,并对医护人员的皮肤损伤发生率、损伤类型及流行特征进行统计分析。结果　共回收有效问卷2 901份,来源于我国19个省、3个自治区、4个直辖市的145家医院。其中,男214例（7.38%）、女2 687例（92.62%）,医生147例（5.07%）、护士2 754例（94.93%）。825例（28.44%）医护人员因佩戴防护装备发生皮肤损伤,合计皮肤损伤数量为2 794处。主要皮肤损伤类型为压力性损伤〔771例（26.58%）,人均2.53处〕、潮湿相关性皮肤损伤〔256例（8.83%）,人均2.77处〕、皮肤撕裂伤〔42例（1.45%）,人均3.12处〕。在发生皮肤损伤的825例医护人员中,存在≥2类皮肤损伤者221例（26.79%）。单因素分析显示：对于防护装备所致皮肤损伤发生率,男性高于女性（P<0.05）,31~45岁者高于≤30岁者（P<0.016 7）,工龄>10年者高于工龄<5年者（P<0.016 7）,医生高于护士（P<0.05）,武汉防疫定点医院高于其他医院（P<0.003 3）、其他医院中传染科高于其他科室（P<0.003 3）,三级防护高于二级防护、二级防护高于一级防护（P<0.016 7）,而不同连续佩戴时间医护人员皮肤损伤发生率间无统计学差异（P>0.05）。结论　抗疫防护装备所致医护人员皮肤损伤的发生率较高,并有多种类型、多个部位损伤并存现象,建议采取减压、减轻摩擦力、吸湿、护肤的综合预防措施减少医护人员皮肤损伤,同时关注性别、年龄、工作岗位等人力资源管理因素。     

Worksite Wellness for the Primary and Secondary Prevention of Cardiovascular Disease in Japan: The Current Delivery System and Future Directions

In the Japanese workplace, employers are required to provide annual health checkups for workers in accordance with the “Industrial Safety and Health Law,” which also mandates that an occupational physician be assigned to companies employing at least 50 workers. The annual medical examination includes testing for the early detection of cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, and the metabolic syndrome. This approach has successfully contributed to the extremely low incidence of coronary artery disease among Japanese workers. However, problems such as poor health and the low rate of participation in health checkups among small-scale companies still persist. Furthermore, although most wellness delivery systems in Japan employ strategies targeting high-risk individuals, instituting a strategy addressing the broader population irrespective of screening may be effective in reducing disease risk in the overall population. As a future direction, we should therefore develop practical methods for implementing a population strategy.     

Worksite Health and Wellness Programs in India

Worksite health and wellness (WH&W) are gaining popularity in targeting cardiovascular (CV) risk factors among various industries. India is a large country with a larger workforce in the unorganized sector than the organized sector. This imbalance creates numerous challenges and barriers to implementation of WH&W programs in India. Large scale surveys have identified various CV risk factors across various industries. However, there is scarcity of published studies focusing on the effects of WH&W programs in India. This paper will highlight: 1) the current trend of CV risk factors across the industrial community, 2) the existing models of delivery for WH&W in India and their barriers, and 3) a concise evidence based review of various WH&W interventions in India.     

Overview of the biochemical and genetic processes in malignant mesothelioma

Malignant mesothelioma (MM) is a highly aggressive form of cancer, has a long latency period, and is resistant to chemotherapy. It is extremely fatal, with a mean survival of less than one year. The development of MM is strongly correlated with exposure to asbestos and erionite, as well as to simian virus 40. Although various countries have banned the use of asbestos, MM has proven to be difficult to control and there appears to be a trend toward an increase in its incidence in the years to come. In Brazil, MM has not been widely studied from a genetic or biochemical standpoint. In addition, there have been few epidemiological studies of the disease, and the profile of its incidence has yet to be well established in the Brazilian population. The objective of this study was to review the literature regarding the processes of malignant transformation, as well as the respective mechanisms of tumorigenesis, in MM.     

Outcomes of a consultation service to emergency medicine clinicians for postexposure management of occupational bloodborne pathogen exposures

Potential bloodborne pathogen exposures, many of which occur after hours and are evaluated by emergency medicine physicians, are an important occupational hazard. Emergency medicine physicians might not be as conversant with the latest US Public Health Service guidelines as occupational medicine physicians. This research presents an efficient model in which a single expert occupational medicine physician provides guidance to many emergency medicine clinicians. Outcomes evaluation indicates that the service was widely utilized and highly rated.     

Toxic hepatitis in occupational exposure to solvents

The liver is the main organ responsible for the metabolism of drugs and toxic chemicals, and so is the primary target organ for many organic solvents. Work activities with hepatotoxins exposures are numerous and, moreover, organic solvents are used in various industrial processes. Organic solvents used in different industrial processes may be associated with hepatotoxicity. Several factors contribute to liver toxicity; among these are: species differences, nutritional condition, genetic factors, interaction with medications in use, alcohol abuse and interaction, and age. This review addresses the mechanisms of hepatotoxicity. The main pathogenic mechanisms responsible for functional and organic damage caused by solvents are: inflammation, dysfunction of cytochrome P450, mitochondrial dysfunction and oxidative stress. The health impact of exposure to solvents in the workplace remains an interesting and worrying question for professional health work.     

北京市监狱干警艾滋病职业暴露防护知识调查分析

目的了解北京市监狱干警艾滋病职业暴露相关知识的知晓情况,为今后对监狱干警开展艾滋病职业暴露及防护知识培训提供依据。方法采用自行设计的问卷,对108名监狱干警就艾滋病职业暴露相关知识进行调查。按回答题的正确数计算知晓率/%。结果共调查21道艾滋病职业暴露及防护知识题,总体知晓率为70.37%(1 596/2 268);6道暴露后应急处理措施题的正确掌握率为74.85%(485/648)。性别、文化程度、从警时间、职业类别之间的职业暴露及防护知识知晓率有显著性差异。结论应加强监狱干警艾滋病职业暴露防护知识培训,使之掌握正确的暴露后应急处理措施,提高他们对艾滋病的防护意识和自我保护能力,并将教育重点放在一线工作的监管干警。     

Applications of complementary therapies during rehabilitation for individuals with traumatic Spinal Cord Injury: Findings from the SCIRehab Project

Objective: Evaluate the use of complementary therapies during rehabilitation for patients with traumatic spinal cord injury (SCI).

Design: Secondary analyses were conducted to identify the use and associated outcomes of complementary therapies provided by occupational therapists (OTs) and physical therapists (PTs) during rehabilitation from a public dataset.

Setting: Inpatient rehabilitation.

Participants: A public dataset composed of 1376 patients with SCI that were enrolled in a five-year, multi-center investigation, the SCIRehab Project. Secondary analyses focused on a subset of 93 patients (47 who received complementary therapy during treatment and 46 case-matched controls who received no complementary therapy).

Interventions: OTs and PTs recorded use of complementary therapies during sessions, including yoga, Pilates, tai chi, aromatherapy, relaxation techniques, imagery and other.

Outcome Measures: Pain interference, pain severity, mobility, and social integration.

Results: Three percent of participants received any complementary therapies. Patients who received complementary therapies showed greater reductions in pain severity from 6 months to 12 months relative to matched controls. Furthermore, the amount of time that patients received complementary therapies during physical therapy sessions was associated with reduced pain interference at 6 months and with reduced pain severity at the 6-month and 12-month follow-ups. Complementary therapy use was not associated with mobility or social integration.

Conclusion: The current study provides preliminary evidence documenting the limited use of complementary therapies in rehabilitation settings and highlights the opportunity for further research, particularly regarding pain-related outcomes.